Peri-implant diseases triggered by oral microdysbiosis: pathogenesis and precision intervention strategies

Abstract

Peri-implant disease is a chronic infection-induced inflammation condition affecting tissues around dental implants, categorized into peri-implant mucositis and peri-implantitis. Oral microbial dysbiosis plays an important role in this disease. Currently, researchers face three challenges in establishing the pathogenic link between peri-implant disease and microdysbiosis: (1) elucidating the underlying molecular mechanisms; (2) Clarifying causal links between host and microbiome; and (3) Identifying secondary microbial changes during disease progression. In this review, we systematically classify dysbiosis from a conceptual perspective and outline the immunological associations within each category. We further elaborate on the causes of bacterial dysbiosis and analyze its potential implications for clinical treatment strategies. At the molecular level, understanding the origins, intrinsic and environmental regulatory mechanisms, and downstream effects may be conducive to develop microbiome targeted therapies. This research direction is of great significance for promoting precision medicine in peri-implant disease.

Keywords: dysbiosis; intervention and treatment strategies; oral pathogenic bacteria; peri-implant mucositis; peri-implantitis.

Figure 1

Subgingival microbiome in peri-implant health and disease states. PM, peri-implant mucositis; PI, peri-implantitis; Aa, Aggregatibacter actinomycetem-comitans. Combined with the data in different articles for comparative summary, this figure lists the top seven genus or species in each group and will indicate their groups.

Figure 2

Schematic diagram of the mechanism of peri-implantitis caused by oral microecology. (a) Dysbiosis induces an innate immune response, with a large number of neutrophils infiltrating and macrophages polarizing, forming the M1 phenotype, and releasing pro-inflammatory cytokines. Vascular permeability increases, and the gums swell. (b) As the disease progresses, bacteria flood into the connective tissue, and immune cells such as CD4+, CD8 + gather, and differentiate into Th1, Th2, Th17 and regulatory T cells, etc., releasing pro-inflammatory cytokines IL-1β, IL-6, TNF-α, etc. Bone marrow mesenchymal stem cells differentiate into osteoclasts, leading to a large amount of alveolar bone absorption (Gasmi Benahmed et al., 2022; Checchi et al., 2020; Huang et al., 2024; Osta, 2014; Plemmenos, 2022; Abdulhameed and Omar, 2022).

Figure 3

Diagnosis and treatment strategies of peri-implant diseases based on microdysbiosis. Advanced microbiome analysis tools are powerful means to prevent/diagnose peri-implant diseases; based on the microecological perspective, microbial therapies including phage therapy, probiotics treatment, oral microbiome transplantation are more effective and promising new therapies for the treatment of peri-implant diseases. PM, peri-implant mucositis; PI, peri-implantitis.